A client diagnosed with Brief Psychotic Disorder is pacing the milieu and occasionally punches the wall.Which is the initial nursing action?
A)Assertively instruct the client to stop punching the wall.
B)Encourage the client to write down feelings in a journal.
C)With the help of staff,initiate seclusion protocol.
D)Ensure adequate physical space between the nurse and the client.

Question

Quizplus · Accepted Answer

The initial nursing action should be to ensure the physical safety of both the client and the nurse. Therefore, providing adequate physical space between the nurse and the client is the priority. Option A is not recommended as it may escalate the client's behavior, and option B may not be effective at this moment as the client is in an agitated state. Option C can be considered if the client's behavior becomes more dangerous or unmanageable despite attempts at de-escalation.

A Client Diagnosed with Brief Psychotic Disorder Is Pacing the Milieu